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Medicare coverage for Macular Degeneration or Vision

When it comes to Medicare, it’s important to know what services are covered. While many services are covered under Medicare, there are still inquiries about vision and macular degeneration coverage.

Services that are considered elective, such as vision, dental, and hearing, are usually not covered under Original Medicare. So, will Medicare provide coverage for macular degeneration or vision?

Certain conditions, since they are considered medical, will be covered under Original Medicare. A great example is age-related, Macular Degeneration.

What Vision Services are Covered by Original Medicare?

Conditions such as cataracts surgery and glaucoma treatment are covered benefits.

Medicare will cover diseases or illnesses related to vision services. If you’re at risk for having glaucoma or you’ve been diagnosed with diabetes, then Medicare Part B will cover an annual eye exam.

Also, treatment of medical conditions such as infections and screenings for hereditary conditions are usually covered by Medicare.

What Vision Services are Not Covered by Original Medicare?

There are many options available for Medicare Beneficiaries to choose important services that are not considered medically necessary, such as a stand-alone Vison, Dental or Hearing policy.

Vision Services Medicare won’t cover:

  • Routine vision care like an eye exam
  • Glasses without cataracts
  • Contacts

 

Medicare will only cover diseases and infections of the eye. If your treatment is considered Medically necessary, you might receive coverage.

Routine eye care isn’t considered necessary unless there is an underlying medical condition making it necessary, such as diabetes or glaucoma risk.

Will a Medigap Plan offer coverage for Macular Degeneration?

A Medicare Supplement, often referred to as Medigap, covers the gaps in Original Medicare.

Macular Degeneration is covered under Original Medicare, so a Medigap plan will be required to cover treatments for it as well. When you have a Medicare Supplement, the insurance carrier covers the 20% that Medicare isn’t covering.

Having a Medicare Supplement plan allows you to choose any doctor in the nation that accepts Medicare Assignment. Meaning you have more freedom and a better chance for quality care.

Is Macular Degeneration Covered by a Medicare Advantage Plan?

A Medicare Advantage plan is required to provide coverage at least as good as Original Medicare.

It’s important to know that just because they’re required to cover everything that Original Medicare does, it doesn’t mean the treatment and doctors choice’s you have with Original Medicare are the same.

When enrolling into a Medicare Advantage plan it’s important for you to review the follow documents:

  • The Provider Directory
  • Drug Formulary
  • Evidence of Coverage.

 

Medicare Advantage plans require you to follow their network of doctors, hospitals and specialists.

This means your doctor may recommend one treatment and your plan can come back and say, no you can be treated but it must be this lesser cost option.

Having Macular Degeneration

Many people live with Macular Degeneration, one of the biggest tips to dealing with it is learning contrast.

For many people with the condition, it is difficult to tell the difference between certain colors, such as black and navy blue.  Using items that provide a sharp contrast will help improve the ease of simple life tasks.

If you have a light-colored countertop or table, then using dark-colored drinking glasses or dishes will help you see things more clearly.

As the condition continues to develop, blurry or blind spots can start to appear in the center of your vision. Then, with time these spots can get larger.

When this occurs driving, reading, an even recognizing faces, becomes difficult.

Medicare & Macular Degeneration

Macular Degeneration is a severe disorder that causes vision loss. It is common for beneficiaries to be battling this condition; fortunately, Original Medicare will cover it.

There are two different types of Macular Degeneration:

  1. The Dry type progresses slower and causes small white or yellowish deposits to form on the retina.  This causes deterioration over time.
  2. Wet Macular Degeneration is when abnormal blood vessels develop under the retina and grow toward the macula.  These blood vessels tend to bleed, leak fluid, or break causing damage to the macula and causing it to pull away from his base.

Macular Degeneration Treatments?

The treatment for Macular Degeneration is considered medically necessary; hence they will be covered by Medicare.

Some examples of treatments covered for Macular Degeneration are Lucentis, Eylea, and Verteporfin. While there are many other covered treatments, these are some of the most common.

Dental, vision, and hearing services are usually aren’t medically necessary and therefore, not covered.

How do I Help a Family Member or Loved One with Macular Degeneration?

When someone becomes visually impaired, they can start to feel isolated and depressed.

Over time, frustration sets in due to tasks that used to be routine becoming difficult, and even some hobbies and leisure activities can seem impossible.

Make sure you keep encouraging them to take on challenges and resolve problems without feeling overwhelmed. Just being a friend can make a difference.

Care requires a team effort of health care professionals, family and friends and sometimes even community volunteers.

How do I Approach Needing to ask for Help with Macular Degeneration?

While it’s very important to try and maintain your independence. You should speak to family members for assistance with certain things that are increasingly more difficult.

Don’t let pride get to you, we all need help at some point in life. The only way to receive help, is to ask for it. If you never ask, you’re denying yourself help.

Having a direct conversation with someone to let them know what you’re having difficulty with and learning your limitations will help ease the frustration.

There are many Low-Vision organizations dedicated to helping people with developing vision impairments. Reaching out to community organizers could benefit you tremendously.

Most Importantly, you can get assistance with low-vision aids for daily activities, government benefits, and large print and audio materials.

 

 

About the Author

Jagger Esch

Jagger Esch is the President & CEO of Elite Insurance Partners and MedicareFAQ, a senior healthcare learning resource center. As a young entrepreneur and seasoned insurance expert, he has a passion for helping people. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. Jagger lives in the Florida sunshine state and loves boating with his family on the weekends.

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